title: Assessing the effectiveness of surface cleaning methods in intravitreal injection procedure rooms.
abstract: OBJECTIVE
  To assess cleaning effectiveness of room surfaces in an office-based intravitreal injection practice by using adenosine triphosphate (ATP) luminometry.
  
  
  METHODS
  Prospective, comparative case series.
  
  
  METHODS
  A total of 792 intravitreal injection room surfaces were sampled (396 before cleaning, 396 after cleaning) using 3 cleaning methods.
  
  
  METHODS
  Three cleaning methods were evaluated: baseline terminal cleaning, directed terminal cleaning, and enhanced terminal cleaning. For each method, residual ATP bioburden (relative light units [RLUs]/sample) was sampled from 9 high-touch injection room surfaces before and after terminal cleaning using the 3M Clean-Trace ATP System (3M Inc, St. Paul, MN). Surface ATP RLUs were used to compare cleaning methods and against an ATP benchmark of fewer than 250 RLU. Differences between cleaning methods were compared by using paired t tests with Bonferroni correction for 3 comparisons.
  
  
  METHODS
  Surface ATP RLU levels.
  
  
  RESULTS
  In baseline terminal cleaning and directed terminal cleaning, the median ATP level of all surfaces exceeded threshold when sampled after terminal cleaning (391 RLU and 264 RLU, respectively), and levels were increased significantly at the completion of the injection clinic and before terminal cleaning (780 RLU and 626 RLU, respectively; P < 0.003). In enhanced terminal cleaning, the median ATP level was below threshold after terminal cleaning (71 RLU), was unchanged at the completion of injection clinic and before terminal cleaning (63 RLU; P = 0.27), and was significantly lower than after the baseline terminal and directed terminal cleaning methods (P < 0.003).
  
  
  CONCLUSIONS
  An easily adopted enhanced terminal cleaning program reduced surface ATP bioburden in intravitreal injection rooms to less than clean benchmarks used in nonophthalmologic healthcare settings.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sejal R
authors.initials: SR
authors.lastname: Amin
authors.affiliation: Department of Environmental Services, Mayo Clinic, Rochester, Minnesota.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Folkert
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address: erie.jay@mayo.edu.
authors.forename: Jay C
authors.initials: JC
authors.lastname: Erie
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis*; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D001419:Bacteria / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D004203:Disinfection / Q000379:methods*; D004783:Environmental Microbiology; D006801:Humans; D017053:Infection Control / Q000592:standards*; D058449:Intravitreal Injections; D008163:Luminescent Measurements; D011446:Prospective Studies; D011785:Quality Assurance, Health Care
chemical_list: D020533:Angiogenesis Inhibitors; D000255:Adenosine Triphosphate